Critical Appraisal of a Trial on High Flow Humidified Oxygen for Bronchiolitis

Running head: CRITICAL APPRAISAL
CRITICAL APPRAISAL
Name of the Student:
Name of the University:
Author note:

1CRITICAL APPRAISAL
Question 1
The trial conducted by Kepreotes et al., (2017) successfully addressed a clearly focused
issue since the population recruited, the intervention applied, the outcomes measured and the
comparator used were clearly relevant to the research objective as mentioned below (Shea et al.,
2017).
Population
The population recruited for the study included a children under the age group of 24
months who were suffering from bronchiolitis which is relevant to the objective to compare
respiratory support efficacy.
Intervention
The trial employed an intervention of assessing the efficacy of high flow humidified
oxygen (HFWHO) as an appropriate respiratory support during bronchiolitis which is relevant to
the primary objective. Hence, this trail addressed a clearly focused issue since the intervention is
relevant to the research objective.
Comparator
The comparator used in the trial is the standard treatment of low-flow nasal cannula
oxygen which is with relevance to the research objective of comparing the efficacy between
respiratory support systems of HFWHO and low-flow nasal cannula oxygen – hence indicating
the addressing of a clearly focused issue.

2CRITICAL APPRAISAL
Outcomes
The outcome of the trial was the time allocated from the randomization to the final usage
of oxygen therapy, which is a key marker of assessing respiratory support efficacy and is with
relevance to the research objective, hence making this trial clearly focused and valid.
Question 2
Treatment Assignment
Kepreotes et al., (2017) stated the children were randomly allocated into three stratified
groups in accordance to their gestational age which indicates that the patients were randomized t
their respective allocation groups. Randomization is considered as the gold standard in research
to prevent bias hence making this a major strength of this trial (Thall, Fox & Wathen (2015).
Allocation Concealing
The authors clearly mentioned that the allocation sequence was hidden within envelopes
which were opaquely concealed and handled exclusively by the leading researcher Kepreotes et
al., (2017). Concealment of allocation is a key way of preventing bias since it blinds patients and
supporting researchers to know about the next allocation treatment hence making this a valid,
significant research. However the allocation for treatment was not possible for blinding by the
authors since both treatment had visual differences and hence, may be a cause of concern for bias
possibility (Schulz et al., 2018).

3CRITICAL APPRAISAL
Question 3
Presence of premature trial termination
There was no indication of the trial being stopped early which is indicative of successful
trial completion comprising of all relevant data from all subjects. However, considering that this
was not clearly mentioned by the authors – this is a notable limitation (LoBiondo-Wood &
Haber, 2017).
Group Analysis
Kepreotes et al., (2017) have clearly mentioned that a total of 202 children were
randomly allocated to the trial groups after extensive exclusion and parental consent and further
mentioned that 101 children were equally allocated to each group. This is indicative of an equal
group analysis which is a major research strength. Further, the authors clearly mentioned the
absence of any withdrawn subject and the inclusion of all 202 patient data indicating that all trial
patients were accounted for analysis and conclusion – hence, signifying credible research
validity (Mi, 2017).
Question 4
It has been clearly mentioned that authors were unable to blind the patients, workers and
researchers to the treatment of HFWHO and low-flow nasal cannula oxygen since both
procedures have visually different characteristics Kepreotes et al., (2017). This can be considered
as a major limitation of this study since lack of blinding increases the susceptibility of bias which
in this case, can exist in the form of bias in the administration of differential modes of respiratory
support delivery (McShane & Gal, 2015).